Measuring the next big thing

“Second wave” emphasizes value, not volume

If healthcare of the past was about how much you do, then healthcare of the future is about making sure you do it well and for a good price. A report from the American Hospital Associations’ (AHA) Hospitals in Pursuit of Excellence platform looks at this “second wave” and how we’ll be measuring its successes — and failures — down the road.

“Metrics for the Second Curve of Health Care” lists four “imperatives”:

• aligning hospitals, physicians and other clinical providers across the continuum of care;

• utilizing evidence-based practices to improve quality and patient safety;

• improving efficiency through productivity and financial management;

• developing integrated information systems.

Each item on that must-do list includes a list of metrics. For instance, with regard to aligning hospitals, physicians and others across the continuum of care, there are measures such as distribution of shared bonuses and the percentage of physicians in leadership positions. For using evidence-based practices, metrics include effective measurement and management of care transitions.

The report — available at — expands on each imperative and its recommended metrics. It outlines what it is that would put a hospital at the beginning of the curve, transitioning, or well into the second curve. There is a link in the report for an associated self-assessment tool, too.

For quality managers, the report is a useful tool, says Heather Jorna, MHSA, vice president of health care innovation at the AHA’s Health Research and Educational Trust in Chicago. “We are all on this quality journey to improve care for our patients,” she says. “Patient safety professionals and hospitals are eager to understand next steps. This report provides a framework and guidance for those on the front lines to assess their work and think about how they can do even more.”

The things listed in the report and self-assessment aren’t things you should feel bad about not having done or mastered yet: These are the focus of what’s coming down the pipeline and which hospitals and health systems will have to focus on to be successful in the future, says Jorna.

You may look through the report and find you are already doing some of what is in there. Jorna notes, though, that others may find some new ideas and strategies, new ways of thinking that might complement what you are already doing. This isn’t the only thing you need to get ready for the future of healthcare, she adds: It is one more tool in your box. In the end, healthcare is all local anyway, and what works in one community might not work in another.

“Healthcare is rapidly changing, and the Affordable Care Act has introduced some uncertainty into our work,” Jorna says. “We know we have to improve quality and doing this will not come about with a ‘one size fits all’ approach.”

This is a follow-up report to one that outlined 10 must-do strategies that would be critical for hospitals in what she calls a “transformational” period. The four noted above have the highest priority. Of those, the one related to utilizing evidence-based practices to improve quality and patient safety is perhaps the most appropriate one to emphasize for quality managers.

“I think broadly you have to look at measuring and creating organized processes, strategies that address the shift toward value-based care delivery, and ultimately addressing value, integration, the ability to meet patient expectations and clinician engagement on all levels.”

The self-assessment linked to the report is a way to get more specific for your own needs, she says. “We know all hospitals are different and their approach to improving care will reflect that. The assessment will give hospitals a chance to think through some specifics. By taking the self-assessment they can better understand where they are currently.”

She hopes that quality managers aren’t the only ones who find use in the report: Hospital leadership can make use of it, too. “It will help hospital leaders determine their current position and progress along the continuum toward meeting the second curve metrics, including all of those related to patient safety and quality.”

For more information on this topic, contact Heather Jorna, MHSA, Vice President, Health Care Innovation, Health Research & Educational Trust, American Hospital Association, Chicago, IL. Telephone: (877) 243-0027.